Section 7(6) of the National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 2013 requires clinical commissioning groups, NHS England and, with respect to their public health functions, local authorities to comply with the recommendations in this appraisal within 3 months of its date of publication.
The Welsh Assembly Minister for Health and Social Services has issued directions to the NHS in Wales on implementing NICE technology appraisal guidance. When a NICE technology appraisal recommends the use of a drug or treatment, or other technology, the NHS in Wales must usually provide funding and resources for it within 3 months of the guidance being published.
When NICE recommends a treatment 'as an option', the NHS must make sure it is available within the period set out in the paragraphs above. This means that, if a patient has Philadelphia-chromosome-positive chronic myeloid leukaemia and the doctor responsible for their care thinks that imatinib is the right treatment, it should be available for use, in line with NICE's recommendations.
All clinicians who treat people with CML should review their current policies and practice in line with the guidance set out in section 1.
Local guidelines or care pathways for the care of patients with CML should incorporate the guidance.
To measure compliance locally with the guidance, the following criteria could be used. Further details on suggestions for audit are presented in section 10.
Imatinib is provided as first-line treatment for the management of an individual with Philadelphia-chromosome-positive CML in the chronic phase.
Imatinib is considered as an option for the treatment of an individual with Philadelphia-chromosome-positive CML who initially presents in the accelerated phase or in blast crisis or who presents in the chronic phase and then progresses to the accelerated phase or blast crisis if he or she has not received imatinib previously.
For an individual in chronic-phase CML who is currently receiving IFN-alfa as first-line treatment, the decision to change to imatinib is informed by the response of the disease to current treatment and the individual's tolerance of IFN-alfa, after informed discussion between the individual and the clinician responsible for treatment.